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[Introduction] Psychosocial factors are associated with chronic low back pain (CLBP), but there are no known reports of screening for psychosocial factors and combined acupuncture and Kampo treatment for this. We present the case of a patient with CLBP with neuralgia of the posterior right thigh whose quality of life (QOL) improved after evaluation of psychological factors and treatment with acupuncture and saibokuto.[Case presentation] A 38-year-old woman developed low back pain with neuralgia in the posterior right thigh in August of the X year. She visited a nearby orthopedic clinic and was diagnosed with a lumbar disc herniation. In November she visited a nearby psychiatric clinic because she noticed dizziness, was diagnosed with an adjustment disorder and was prescribed bromazepam. Six months later, she was diagnosed with sciatica by an orthopedic surgeon at our hospital. In the following month, she visited the psychiatrist at our hospital and was diagnosed with depression in April. In April, she also visited our department, hoping for improvement of her low back pain and neuralgia in the posterior right thigh. Neurological and orthopedic manual examinations showed normal results, but pain in the lumbar region when flexing the trunk and baikakuki and kyo-kyo-kuman were noted. The Keele STarT Back Screening Tool classified her under medium risk, and the Roland-Morris Disability Questionnaire (RDQ) showed a score of 16 with a deviation score of 1.22. We administered acupuncture and saibokuto to improve her symptoms. The acupuncture treatment was performed on the right L2/L3 lateral sacral border, piriformis equivalent area, BL37, and BL40. As a result, after the third acupuncture treatment, her RDQ score improved to 2 points and the deviation score to 50.14 points.[Discussion] Our results suggest that acupuncture and saibokuto may improve the QOL of CLBP patients with neuralgia in the lower limbs who have psychological factors.
RESUMO
There is little common understanding among acupuncturists regarding the poor prognosis for peripheral facial paralysis, evaluation methods, precautions during treatment, including acupuncture and moxibustion treatment. Cooperation among relevant occupations is also a major issue. Currently, the treatment of paralysis is focused on how to minimize sequelae during the recovery process of paralysis in cases with poor prognosis. The goal is to prevent sequelae and improve patient quality of life (QOL). For that purpose, it is important to understand the guidelines for medical treatment of paralysis, and like other medical staff, the acupuncturist should provide appropriate medical examination, treatment, self-care guidance, etc., and cooperate with other medical specialists. We hope that this seminar will provide a common understanding of the pathophysiology and evaluation methods of paralysis, precautions for acupuncture and moxibustion treatment, and a consensus of clinical research and the future possibility of using acupuncture and moxibustion in the treatment of paralysis.
RESUMO
[Objective] This report describes a patient with bilateral peripheral facial paralysis who was strongly suspected to have neurosarcoidosis and whose facial paralysis improved after acupuncture treatment.[Case] A 73-year-old man developed right facial nerve paralysis on July 24, X followed by left facial nerve paralysis three days later. The patient visited our Department of Neurology on August 2 and was hospitalized the next day. Upon examination, neurosarcoidosis was strongly suspected, and steroid pulse therapy was performed until he was discharged from the hospital on August 26. On September 13, still experiencing bilateral facial paralysis, the patient was referred to our department for acupuncture treatment. The patient's height was 159 cm and weight was 48.6 kg. Valley signs and pathologic reflexes were negative, and deep tendon reflexes and sensory tests of the upper and lower extremities were normal. MMT was fair only for the dorsiflexion movement of the left ankle. The Yanagihara score was 26 on the right and 10 on the left. Facial muscle contraction response to electrical acupuncture stimulation targeting the facial nerve showed contraction at 0.04 mA on the right side and no contraction at 0.30 mA on the left side. According to these examinations, the right side was considered to be mildly paralyzed and the left side was considered to be severely paralyzed, and acupuncture was performed to improve the symptoms of paralysis and prevent sequelae.[Treatment] Acupuncture was applied to GB2 and ST7 on the right side of the face. On the left side, acupuncture needles were placed on the frontalis muscle, orbicularis oculi muscle, elevator muscle of upper lip and wing of nose, nasalis muscle, zygomaticus major and minor muscle, orbicularis oris muscle, depressor angle oris muscle, and platysma muscle. From the 106th day of illness, asynchronous electroacupuncture was applied to the left side only. Acupuncture was performed once or twice a week for 10 minutes per session. The degree of paralysis was assessed by the Yanagihara score.[Progress] Acupuncture was combined with corticosteroids prescribed by the Department of Neurology. As a result, the right side had a score of 38 points after 170 days after start of illness and the left side had a score of 38 points after 204 days.[Discussion and Conclusion] The combined treatment of medication and acupuncture was effective and showed excellent results for this patient taking into account the degree of facial nerve damage. Acupuncture may be considered as an effective treatment option for bilateral peripheral facial paralysis.